ACGME-International Advance Specialty-Specific Program Requirements for Graduate Medical Education in Transitional Year

ACGME International

Advanced Specialty Program Requirements for

Graduate Medical Education in the

Transitional Year

Reformatted: 1 April 2022

Reformatted: 1 July 2016

Initial Approval: 20 September 2011

Transitional Year 1

ACGME International Specialty Program Requirements for

Graduate Medical Education

in Transitional Year

Int. Introduction

Background and Intent: Programs must achieve and maintain Foundational Accreditation

according to the ACGME-I Foundational Requirements prior to receiving Advanced

Specialty Accreditation. The Advanced Specialty Requirements noted below

complement the ACGME-I Foundational Requirements. For each section, the Advanced

Specialty Requirements should be considered together with the Foundational

Requirements.

Int. I. Definition and Scope of the Educational Program

The objective of the transitional year is to provide a well-balanced program of

graduate medical education in multiple clinical disciplines designed to facilitate

the choice of and preparation for education in a specific specialty. The

transitional year must be designed to fulfill the educational needs of medical

school graduates who:

a) have chosen a career specialty for which the categorical program in graduate

medical education has, as a prerequisite, one year of fundamental clinical

education (this education may also contain certain specific experiences for

development of desired skills);

b) desire a broad-based year to assist them in making a career choice or

specialty selection decision;

c) are planning to serve in public health organizations or on active duty in the

military as general medical officers or primary flight/undersea medicine

physicians; or,

d) desire or need to acquire at least one year of fundamental clinical education

before entering administrative medicine or non-clinical research.

Int. II. Duration of Education

Int. II.A. The educational program in the transitional year must be 12 months in length.

I. Institution

I.A. Sponsoring Institution

I.A.1. The transitional year program must be offered by an institution conducting

two or more residency programs accredited by and in good standing with

the ACGME-I.

Transitional Year 2

I.A.1.a) One of the ACGME-I residency programs must be in a discipline

that provides fundamental clinical skills education and training in

emergency medicine, family medicine, internal medicine,

obstetrics and gynecology, pediatrics, or general surgery.

I.B. Participating Sites

See International Foundational Requirements, Section I.B.

II. Program Personnel and Resources

II.A. Program Director

II.A.1. The program director must forward performance evaluations of residents

accepted into an advanced specialty residency to the specialty program

director following completion of the transitional year.

II.A.2. The program director must verify that each resident has demonstrated

sufficient competence and has successfully completed the program.

II.B. Faculty

See International Foundational Requirements, Section II.B.

II.C. Other Program Personnel

See International Foundational Requirements, Section II.C.

II.D. Resources

II.D.1. Pathology, radiology, and nuclear medicine facilities must exist at the

primary clinical site.

II.D.1.a) These facilities must be directed by qualified physicians who are

committed to medical education and to providing competent

instruction to the transitional year residents when patients require

these diagnostic and/or therapeutic modalities.

III. Resident Appointment

III.A. Eligibility Criteria

See International Foundational Requirements, Section III.A.

III.B. Number of Residents

III.B.1. There must be at least four residents in the program.

III.C. Resident Transfers

See International Foundational Requirements, Section III.C.

Transitional Year 3

III.D. Appointment of Fellows and Other Learners

See International Foundational Requirements, Section III.D.

IV. Specialty-Specific Educational Program

IV.A. ACGME-I Competencies

IV.A.1. The program must integrate the following ACGME-I Competencies into

the curriculum.

IV.A.1.a) Professionalism

IV.A.1.a).(1) Residents must demonstrate a commitment to

professionalism and an adherence to ethical principles.

Residents must demonstrate:

IV.A.1.a).(1).(a) compassion, integrity, and respect for others;

IV.A.1.a).(1).(b) responsiveness to patient needs that supersedes

self-interest;

IV.A.1.a).(1).(c) respect for patient privacy and autonomy;

IV.A.1.a).(1).(d) accountability to patients, society, and the

profession; and,

IV.A.1.a).(1).(e) sensitivity and responsiveness to a diverse patient

population, including to diversity in gender, age,

culture, race, religion, disabilities, and sexual

orientation.

IV.A.1.b) Patient Care and Procedural Skills

IV.A.1.b).(1) Residents must provide patient care that is compassionate,

appropriate, and effective for the treatment of health

problems and the promotion of health. Residents must

demonstrate competence in:

IV.A.1.b).(1).(a) obtaining a comprehensive medical history;

IV.A.1.b).(1).(b) performing a comprehensive physical examination;

IV.A.1.b).(1).(c) assessing patient problems;

IV.A.1.b).(1).(d) making appropriate use of diagnostic studies and

tests;

IV.A.1.b).(1).(e) integrating information to develop a differential

diagnosis; and,

Transitional Year 4

IV.A.1.b).(1).(f) implementing a treatment plan.

IV.A.1.c) Medical Knowledge

IV.A.1.c).(1) Residents must demonstrate knowledge of established

and evolving biomedical clinical, epidemiological, and

social-behavioral sciences, as well as the application of

this knowledge to patient care.

IV.A.1.c).(1).(a) Residents must demonstrate knowledge of the

scientific method of problem solving and evidence-

based decision-making.

IV.A.1.d) Practice-based Learning and Improvement

IV.A.1.d).(1) Residents must demonstrate the ability to investigate and

evaluate their care of patients, to appraise and assimilate

scientific evidence, and to continuously improve patient

care based on constant self-evaluation and lifelong

learning. Residents are expected to develop skills and

habits to be able to meet the following goals:

IV.A.1.d).(1).(a) identify and perform appropriate learning activities;

IV.A.1.d).(1).(b) identify strengths, deficiencies, and limits in one’s

knowledge and expertise;

IV.A.1.d).(1).(c) incorporate formative evaluation feedback into daily

practice;

IV.A.1.d).(1).(d) locate, appraise, and assimilate evidence from

scientific studies related to their patients’ health

problems;

IV.A.1.d).(1).(e) participate in the education of patients, patients’

families, students, other residents, and other health

professionals;

IV.A.1.d).(1).(f) set learning and improvement goals;

IV.A.1.d).(1).(g) systematically analyze practice using quality

improvement methods, and implement changes

with the goal of practice improvement; and,

IV.A.1.d).(1).(h) use information technology to optimize learning.

IV.A.1.e) Interpersonal and Communication Skills

Transitional Year 5

IV.A.1.e).(1) Residents must demonstrate interpersonal and

communication skills that result in the effective exchange

of information and collaboration with patients, their

families, and health professionals. Residents must:

IV.A.1.e).(1).(a) communicate effectively with patients, patients’

families, and the public, as appropriate, across a

broad range of socioeconomic and cultural

backgrounds;

IV.A.1.e).(1).(b) communicate effectively with physicians, other

health professionals, and health-related agencies;

IV.A.1.e).(1).(c) work effectively as a member or leader of a health

care team or other professional group;

IV.A.1.e).(1).(d) act in a consultative role to other physicians and

health professionals; and,

IV.A.1.e).(1).(e) maintain comprehensive, timely, and legible

medical records, if applicable.

IV.A.1.f) Systems-based Practice

IV.A.1.f).(1) Residents must demonstrate an awareness of and

responsiveness to the larger context and system of health

care, as well as the ability to call effectively on other

resources in the system to provide optimal health care.

Residents must:

IV.A.1.f).(1).(a) work effectively in various health care delivery

settings and systems relevant to their clinical

specialty;

IV.A.1.f).(1).(b) coordinate patient care within the health care

system relevant to their clinical specialty;

IV.A.1.f).(1).(c) incorporate considerations of cost awareness and

risk-benefit analysis in patient and/or population-

based care as appropriate;

IV.A.1.f).(1).(d) advocate for quality patient care and optimal patient

care systems;

IV.A.1.f).(1).(e) work in interprofessional teams to enhance patient

safety and improve patient care quality; and,

IV.A.1.f).(1).(f) participate in identifying system errors and

implementing potential systems solutions.

Transitional Year 6

IV.B. Regularly Scheduled Educational Activities

IV.B.1. The teaching and supervision of transitional year residents must be the

same as that provided to residents in the participating categorical

programs.

IV.B.1.a) The planned educational experiences should be part of the

curriculum for categorical residents, as long as the content is

applicable to the transitional year residents’ learning needs.

IV.B.1.b) On those rotations not providing clinical experience in

fundamental clinical skills, such as electives and subspecialty

rotations, residents should participate in planned didactic

experiences that correspond to the clinical experience.

IV.B.2. Residents must have planned educational experiences that occur on

each block rotation throughout the academic year, and in which all

didactic curriculum disciplines must participate.

IV.B.3. Rotations designated as providing fundamental clinical skills should have

planned educational experiences that complement and enhance the

clinical experience.

IV.C. Clinical Experiences

IV.C.1. All required rotations must occur in an ACGME-I-accredited program.

IV.C.2. Residents should have rotations offering fundamental clinical skills that

are at least four continuous weeks in duration to ensure reasonable

continuity of education and patient care.

IV.C.3. Residents must have at least a four week rotation (minimum of 140

hours) in emergency medicine under the supervision of qualified faculty

within the sponsoring institution or an affiliated site.

IV.C.4. All residents must have a structured ambulatory clinical experience within

a primary care specialty’s ambulatory settings at the Sponsoring

Institution or at participating sites used by the program.

IV.C.4.a) The ambulatory experience must provide at least 140 hours of

documented experience.

IV.C.4.a).(1) This experience must be scheduled in no shorter than half-

day sessions.

IV.C.4.b) Faculty physicians’ offices, walk-in/urgent care clinics, and

neighborhood health clinics should be used for these experiences.

IV.C.4.c) Ambulatory clinic sessions should not be interrupted by duties with

inpatient services.

Transitional Year 7

IV.C.5. Residents must have at least 24 weeks of their curriculum in a discipline

or disciplines that offer fundamental clinical skills in the primary

specialties of emergency medicine, family medicine, internal medicine,

obstetrics and gynecology, pediatrics, or surgery.

IV.C.5.a) Subspecialty experiences, with the exception of critical care unit

experiences, must not be used to meet fundamental clinical skills

curriculum requirements.

IV.C.5.b) Residents must have no more than eight weeks designated to

non-clinical patient care experience, such as research,

administration, and computer science.

IV.C.6. Residents must have at least eight weeks of electives, exclusive of

vacation time.

IV.C.6.a) Elective rotations should be determined by the educational needs

of the individual resident.

IV.C.7. Residents must have the opportunity to participate in the evaluation and

management of the care of all types and acuity levels of patients who

present to the Sponsoring Institution’s emergency department.

IV.C.7.a) The transitional year residents must have first-contact

responsibility for these patients.

IV.C.8. No more than eight weeks of transitional year rotations should be taken

away from the institution and its affiliates.

IV.D. Scholarly Activity

See International Foundational Requirements, Section IV.D.

V. Evaluation

V.A. Resident Evaluation

See International Foundational Requirements, Section V.A.

V.B. Clinical Competency Committee

See International Foundational Requirements, Section V.B.

V.C. Faculty Evaluation

See International Foundational Requirements, Section V.C.

V.D. Program Evaluation and Improvement

Transitional Year 8

V.D.1. A Transitional Year Education Committee (TYEC) must be appointed and

have major responsibility for conducting and monitoring the activities of

the program.

V.D.1.a) The TYEC must be convened by the Sponsoring Institution at

least four times in an academic year.

V.D.1.b) The membership of this committee should include:

V.D.1.b).(1) the transitional year program director;

V.D.1.b).(2) program directors (or designees) of disciplines regularly

included in the curriculum;

V.D.1.b).(3) the chief executive officer (CEO) (or designee in hospital

administration) of the Sponsoring Institution; and,

V.D.1.b).(3).(a) The CEO or designee must not be the transitional

year program director.

V.D.1.b).(4) peer-selected residents, one of whom must be a current

transitional year resident.

V.D.2. The TYEC must:

V.D.2.a) ensure adequate resources for the didactic and clinical curriculum

prescribed, to include monitoring the adequacy in number of

patients, variety of illnesses, educational materials,

teaching/attending physicians, and financial support;

V.D.2.b) ensure residents are educated in high-quality medical care based

on scientific knowledge, evidence-based medicine, and sound

teaching by qualified educators;

V.D.2.c) ensure educational opportunities are equivalent to those provided

to first-year residents in the categorical programs in which

transitional year residents participate;

V.D.2.d) review the residents’ assessments of each rotation on a bi-annual

basis;

V.D.2.e) review the curriculum each academic year to ensure the

educational program is current and relevant;

V.D.2.f) review ACGME-I letters of accreditation for all residency programs

through which transitional year residents rotate, and monitor areas

of non-compliance;

V.D.2.g) review the responsibilities of the TYEC at least one a year; and,

Transitional Year 9

V.D.2.h) maintain a record of those in attendance at the meeting and

actions taken during the meeting.

V.E. Program Evaluation Committee

See International Foundational Requirements, Section V.E.

VI. The Learning and Working Environment

See International Foundational Requirements, Section VI.